Rabies is still a fatal but neglected disease: a case report.

BACKGROUND: Rabies, caused by a lyssavirus, is a viral zoonosis that affects people in many parts of the world, especially those in low income countries. Contact with domestic animals, especially dogs, is the main source of human infections. Humans may present with the disease only after a long period of exposure. Nearly half of rabies cases occur in children <15 years old. We report on a fatal case of rabies in a Ghanaian school child 5 years after the exposure incident, and the vital role of molecular tools in the confirmation of the diagnosis. CASE PRESENTATION: The patient, an 11-year-old junior high school Ghanaian student from the Obuasi Municipality in Ghana, presented with aggressive behavior, which rapidly progressed to confusion and loss of consciousness within a day of onset. Her parents reported that the patient had experienced a bite from a stray dog on her right leg 5 years prior to presentation, for which no antirabies prophylaxis was given. The patient died within minutes of arrival in hospital (within 24 hours of symptom onset). Real-time polymerase chain reaction testing of cerebrospinal fluid obtained after her death confirmed the diagnosis of rabies. Subsequent phylogenetic analysis showed the virus to belong to the Africa 2 lineage of rabies viruses, which is one of the predominant circulating lineages in Ghana. CONCLUSION: The incubation period of rabies is highly variable so patients may only present with symptoms long after the exposure incident. Appropriate molecular testing tools, when available as part of rabies control programmes, are vital in confirming cases of rabies.

Assays for laboratory confirmation of novel human coronavirus (hCoV-EMC) infections.

We present a rigorously validated and highly sensitive confirmatory real-time RT-PCR assay (1A assay) that can be used in combination with the previously reported upE assay. Two additional RT-PCR assays for sequencing are described, targeting the RdRp gene (RdRpSeq assay) and N gene (NSeq assay), where an insertion/deletion polymorphism might exist among different hCoV-EMC strains. Finally, a simplified and biologically safe protocol for detection of antibody response by immunofluorescence microscopy was developed using convalescent patient serum.

Dose inhomogeneities on surfaces of different dental implants during irradiation with high-energy photons.

OBJECTIVES: The aim of this study was to determine the radiation doses in mucosa and bone close to the surface of different dental implant materials. METHODS: Radiation dose was measured at the interface of bone or soft tissue and various implant materials for 6 MV photons generated by a medical linear accelerator using a phantom and ultrathin thermoluminescent dosemeters. RESULTS: Increasing thickness of implant materials resulted in a dose decrease in bone immediately behind the implants. Directly in front of titanium implants, dose increases of 18.2% and 30.4% were found in bone and soft tissue, respectively, independent of implant thickness and surface structure (polished/plasma coated). Even a titanium coating with 70 microm hydroxyapatite did not affect the scattering dose. In contrast, for aluminium oxide ceramics, a scatter-induced notable dose increase could not be assessed. CONCLUSIONS: During irradiation with high-energy photons, an implant-induced dose enhancement could be reduced in bone using the technique of multiple fields and in soft tissue using ceramic abutments.

Dentofacial rehabilitation by osteodistraction, augmentation and implantation despite osteogenesis imperfecta.

Osteogenesis imperfecta-- a heritable systemic disorder characterized by enhanced bone fragility-- is frequently associated with a Class III malocclusion and distinct dental disorders. This patient, suffering from a late form of osteogenesis imperfecta, displayed early loss of teeth and severe maxillary hypoplasia. Bone grafting of the alveolar ridge was assumed not to guarantee a neutral basal relation before dental implantation. Due to the risk of atypical fractures conventional orthognathic surgery was excluded in the atrophic maxilla. In contrast to a conventional Le Fort I osteotomy, osteodistraction of the maxilla can be performed omitting the precarious down-fracture procedure. Despite a lack of reports on this technique in patients with osteogenesis imperfecta, dysgnathia was corrected by osteodistraction of the upper jaw. The loss of teeth was treated by augmentation of the alveolar crest using autogenous bone from the iliac crest followed by placement of dental implants. Stable normocclusion of the implant-supported overdentures was achieved without any detectable relapse over 4 years. For the first time it has been demonstrated that advanced surgical techniques like osteodistraction, alveolar crest augmentation and dental implantation can successfully be combined for dentofacial rehabilitation even in patients suffering from osteogenesis imperfecta.

Malignant odontogenic myxoma of the maxilla: case with cytogenetic confirmation.

An odontogenic myxoma of the maxilla with an aggressive clinical course is presented. The tumour arose in a 53-year-old patient, recurred two times after extended maxillectomy and ultimately caused the patient's death by uncontrollable local disease with infiltration of the cranial cavity. Microscopically, the tumour showed histological features of a low grade malignant myxosarcoma with cellular areas, enhanced mitotic activity and nuclear pleomorphism. Cytogenetic analysis revealed an unexpectedly aberrant hypertetraploid chromosome complement, that was considered as incompatible with the usual karyotypic patterns of benign tumours.

[Roentgen diagnosis in oromaxillofacial surgery]. / Röntgendiagnostik in der Mund-, Kiefer-, Gesichtschirurgie.

A vital X-ray imaging technique in oral and craniomaxillofacial surgery is the panoramic X-ray. Due to its variety of special projections, including imaging of the transversal level and low exposure to radiation, it is suitable for answering many clinical questions and for diagnostics of various findings. It has become possible to minimize the necessary doses by further development of technology and devices, as well as of X-ray films and by new detection systems, such as sensors or screens. In some clinical cases, the diagnostic deficiencies of conventional imaging techniques make computed tomography (CT) and magnetic resonance (MR) imaging indispensable. Although MR is particularly suitable for soft tissue imaging, it has also become helpful in finding cortical changes by shorter measuring times. In certain cases, e.g., changes to bone metabolism, differentiated methods of nuclear medicine make image-aided analysis of function possible.

Resorption of microsurgically vascularized bone grafts after augmentation of the mandible.

Vascularized bone grafts taken from the iliac crest to augment the extremely atrophied mandible are valued for their ability to maintain their contour. Reliable data on long-term performance, however, is not yet available. The purpose of this study was to investigate the long-term results of this method, evaluating the radiological documentation (lateral cephalograms, orthopantomograms) of six patients. The mean follow-up period was 7.3 years. Dental implants were not inserted into the bone grafts. The average increase in ridge height immediately after surgery was 17.8 mm in the symphyseal area, 17.1 mm above the mental foramen and 13.9 mm in the molar region. In the first postoperative year, the average vertical loss was 3.0 mm in the symphyseal, 2.0 mm in the premolar and 2.9 mm in the molar regions. After that the mean yearly rate of vertical resorption dropped to 0.24 mm in the symphyseal, 0.27 mm in the premolar and 0.34 mm in the molar regions, which corresponded to the physiological loss in ridge height due to aging. The fact that graft resorption was so slight portends a good long-term prognosis with this procedure. However, indication is restricted by the high operative burden for the patient and by the availability of alternative rehabilitation methods.

[Single-cystic ameloblastoma at an early age. 2 case reports]. / Unizystische Ameloblastome im frühen Wachstumsalter. Zwei Fallberichte.

Two cases of unicystic ameloblastoma in the mandible of young children are described. Conservative surgery is justified in children due to the lower risk of recurrence compared to cases of solid ameloblastoma and the risk of growth disturbance after radical surgery. However, long-term follow-up is necessary.